Injuries to soft tissue and surrounding bones and joints are quite common. In particular, damage to the anterior cruciate ligament (ACL) and the acromioclavicular (AC) joint is very common, with damage to the AC joint being the second most common form of shoulder instability. In addition, injuries can occur to the distal biceps tendon and ankle syndesmosis. The prevalence of these types of injuries is increasing with the increased popularity of sports such as snowboarding. The injury usually occurs when the patient falls, striking the superior aspect of the shoulder with the arm adducted. The reaction force displaces the scapula downward, with progressive strain on the acromioclavicular ligaments, the coracoclavicular ligaments, followed by the deltoid and trapezius musculature and fascia. Treatment of this continuum of injuries depends upon the degree of injury of the aforementioned structures.
Various treatment methods have been proposed for the repair of injuries to the ACL and AC joints. Thornes in US Patent Application Publication No. 2007/0016208A1 describes a first suture anchor-suture-second suture anchor technique to reduce and internally fix the dislocation between the clavicle and the coracoid process. The apparatus of the invention comprises a first or second suture anchor in the form of a button. The button has a first aperture and a second aperture. A first or second suture anchor in the form of a washer is also presented. The washer has at least two flexible coupling-locating apertures. The washer also has a substantially centrally located bone screw-retaining aperture and at least two flexible coupling-locating apertures which are preferably counter-sunk so as to allow easier threading passage of the flexible coupling. In fixing the AC joint, the button and the washer are secured or pre-threaded together by means of a flexible coupling in the form of the first suture which is double looped through the first and second apertures of the button and the peripheral apertures of the washer. The first suture is fed through to an aperture of the washer; through the second and first apertures of the button; through the aperture, under the washer and back out the aperture; through the second and first apertures of the button again; and finally through the aperture of the washer. A needle with a second, pull-through suture is also looped through either the first or second apertures of the button. The second suture is looped through the first aperture of the button. A bone screw is used for engaging the washer with the coracoid process. The two trailing ends of the first suture are pulled to approximate the desired distance between the button and the washer, and hence reduce the interval between the clavicle and the coracoid process.
In another related application, Thornes (US Patent Application Publication No. US 2007/0179531A1) describes an acromioclavicular joint fixation technique which employs two fixation devices (for example, two buttons) joined by a continuous loop of flexible material. Each button is provided with at least one opening that allows the passage of the flexible material. In practicing the technique, a hole is drilled through the clavicle and the coracoid process using a cannulated drill. The cannulated drill is left in the clavicle and the coracoid. A suture is advanced by passing wire through the cannulated drill and the drill is subsequently removed. Two traction sutures are inserted from the oblong button of the fixation system through the wire loop of the suture passing wire. The suture passing wire is pulled to retrieve the two traction sutures out of the anterior/inferior cannula. The oblong button is advanced through the clavicle and the coracoid until it exits the coracoid base. Each of the traction sutures of the oblong button is pulled to flip the button onto the underside of the coracoid base, to secure the oblong button. The suture tails of the round button are pulled to advance the round button down to the surface of the clavicle. Lastly, the sutures are tied to stabilize the acromioclavicular joint.
Martello in U.S. Pat. No. 7,163,540 discloses a surgical anchor having one or more anchor holes distributed around the head of the anchor. The upper and lower apertures of each anchor hole are accessible to attach separate sutures to each of the anchor holes using conventional surgical techniques, i.e. curved needles. The inclined anchor holes allow a surgeon to efficiently attach soft tissue to the soft tissue securing anchor using preferred surgical tools without the necessity of using a multiplicity of specialized tools. The soft tissue securing anchor includes a head and securing end. The securing end may include any conventional means of securing a suture anchor into bone such as threads, barbs, fingers, toggle or molly bolts, and rivets. The head of the suture anchor may include a means for accommodating a drive tool such as a shaped head, tabs, flanges, channels, or one or more drive sockets such as a drive socket for securing the anchor. The soft tissue securing anchor is screwed into bone by applying a torque to soft tissue securing anchor using a conventional surgical drive tool inserted into the drive socket.
There are several problems associated with the aforementioned kits and methods. In particular, with respect to the AC joint, dissection under the coracoid process is required which leads to complications in the healing process. In addition, some of the methods require the use of sharp needles, suture or wires to pull the toggle into position. These instruments must be retrieved from the coracoid process without causing further damage to the coracoid process. Lastly, for those methods that use toggle bolts, the toggle must be pulled inferior to the coracoid which is difficult and potentially dangerous because of the anatomy, including the musculocutaneous nerve.
An object of the present invention is to provide a kit and method for repair of soft tissue, bone and joint damage.
Another object of the present invention is to provide a kit for the delivery of a graft in the repair of soft tissue, bone and joint damage.
Another object of the present invention is to provide a kit comprising a toggle bolt suture anchor and a toggle bolt delivery device where the toggle bolt suture and toggle bolt delivery device form an assembly.
Another object of the invention is to provide a kit comprising a toggle bolt suture anchor and toggle bolt delivery device where the toggle bolt delivery device enables the toggle bolt suture anchor to be pushed into position.